Fiasp Insulin. The New Kid on the Block

Fiasp Insulin the new kid on the blockIt has been a long  time since the diabetes world has seen a new rapid acting insulin brought to market.  The last one that I can remember was  Apidra released back in 2004.  It is  not surprising  then that the release of Fiasp by NovoNordisk is creating a lot of buzz.  Not to be let out, my son recently began using this insulin. Since Fiasp insulin is the new kid on the block, I thought I would give everyone a brief rundown on the highs and lows associated with it.

What is it?

Fiasp insulin was released by NovoNordisk onto the Canadian market in March of 2017.  Many of us scrambled to get a prescription because it promised better blood glucose levels without pre-bolusing for meals! According to the press release, you can dose up to two minutes before a meal and up to 20 minutes after starting a meal without compromising overall glycemic control or safety!*

How is it different?

A Medscape article states that  Fiasp is  absorbed twice as fast as its counterparts.

It does this with the help of  two excipients–Vitamin B3 is responsible for the increase in the speed of absorption and Amino Acid (L-Arginine)  has been added for extra stability.**

What do users think?

All of this science is great but most people are wondering how well it works in real life settings.  From what I have seen, the bulk of users really like it.  I could only find one person out of about a dozen users who had returned to their old insulin aspart.

When I asked my son for his review I was told “I still have highs. I still have lows BUT if I have a heavy carb  loaded meal, Fiasp kicks butt and I don’t have the same crazy swings that I always did before.” For a 19 year old who can definitely binge on carbs, this is huge.

Other users seem to have  had similar results.

Some people with diabetes found that the insulin peaks were no longer as pronounced.  They had some difficulty battling highs with Fiasp however while others found it perfect for corrections. In fact some people are purchasing Fiasp just for corrections.

Other users explained that the faster insulin action allowed them to more quickly respond to rising blood glucose levels.  This in turn meant resulted in much  tighter control.  The quick action has  also left one user to caution about the timing of any  prebolus.

Most seemed to agree that Fiasp insulin resulted in fewer food spikes and more stable blood glucose levels but as I said not everyone loves it.  For some users, their traditional rapid acting insulin seemed to work better.

Final thoughts…

All in all, most people with diabetes who are  trying the new kid on the block seem to be happy with it.  It offers another insulin choice  for those who struggled with post-meal spikes or don’t pre-bolus meals.

It must also be noted however that while Fiasp is not currently approved for use in insulin pumps in Canada, both those on insulin pumps and MDI are using this insulin aspart.

Finally, I was also happy to see that the price of Fiasp insulin was par with NovoRapid.  This meant that there was no need to worry about an increased cost for out of pocket insulin expenses.  My understanding is that Fiasp insulin is not yet on many (or any) provincial formularies.  This most likely will mean that if you decide to use the insulin and are currently using a publicly funded program, you may have to either pay for this insulin out of pocket or speak to your doctor about having special authorization added to your benefits to ensure full coverage.

Please remember to check with your diabetes team before starting any new insulin regimen. 




Diabetes is an exceptionally costly disease

Its Day 2 of Diabetes Blog week and today we look at the high costs of diabetes care.  Diabetes takes a toll on the person living with the disease, on their relationships and on their wallets. Diabetes is an exceptionally costly disease.

diabetes is costlyFrom the moment the diagnosis comes in, your world begins to shatter.  Quickly you learn that the days of grabbing a snack on the run or leaving the house with just your keys are over.

Diabetes means that your brain must constantly be on.  You must always be thinking about carb counts, blood glucose levels, insulin on board, and a thousand other factors that were previously irrelevant to you.  The mental exhaustion is real.  The toll on the person with diabetes, their caregivers and those around them is significant.

When living with diabetes, it is vital to have supports and to use them! When a friend or partner offers to help, accept it. It doesn’t matter if they do things a little differently.  If no one dies, then it’s a win.  Accept the help.  Take a break. You need it.

Unfortunately it is not just the emotional and physical aspects of diabetes care that can be taxing.  Diabetes is an exceptionally costly disease when it comes to your finances as well.  If you don’t have excellent  insurance coverage, the stresses of life with diabetes are magnified a thousand times over.

For those of us living in Canada, there are a few benefits. First, we don’t have the absolutely ridiculously high insulin costs that our friends to the south are being subjected to.  My son was pleasantly surprised when he was forced to buy his first vial of insulin and it cost him less than $40.

$40 for a person who is in school and working part-time is enough of a cost however.  Thankfully his expense is temporary.  He has two options for coverage. He is trying to get back on his father’s insurance because he is in school.  If that becomes more of a hassle than it is worth, he can still apply for the provincial drug plan to help offset the costs of diabetes supplies.

If you don’t have those options however, diabetes is exceptionally costly.  In February of 2015, I sat down and figured out exactly how costly it would be for me to have Type 1 diabetes and use an insulin pump.   I don’t have private health care coverage, I am too old for the current provincial insulin pump program and I wouldn’t qualify for much of a rebate through our provincial program because of income.

For me to use a sensor augmented insulin pump to maintain my diabetes care, in 2015, I established that it would cost me approximately $14,500 per year.  That is over $1200 per MONTH.  Obviously this total would be drastically reduced if I just wanted to use a syringe and injections.  Either way, I would still require insulin, syringes, test strips, ketone strips, alcohol swabs and glucose tablets to just name a few items to stay alive.

Can you imagine being a young adult and having to save, at minimum, the amount of a car payment just to cover your expenses? What if you wanted to have a family but you have diabetes? You need to be able to afford diapers, clothes, food and diabetes supplies for yourself.  Even those who no longer have children are not immune.  No matter what your age, you carry the need to pay for life-sustaining medical equipment for as long as you live.  That must be exhausting.

There is no cure. There is no end in sight.  All those of us who love people with diabetes can do is continue to offer emotional support.  We can continue to assist with care and those of us in the advocacy realm can continue to ask governments and insurance companies to provide greater help.  Diabetes is an exceptionally costly disease. We must do all we can to help our loved ones deal with it.

Diabetes Mine Patient Survey’s telling results

Not surprisingly, I belong to the international group “Diabetes Advocates”.  Yesterday Amy Tenderich from Diabetes Mine posted a link to a graphic and asked that the advocates share or comment as they saw fit.
For me the timing of this graphic was perfect. I had just been having an online conversation with another D-Momma about something very similar. She had stated that her son refused to wear a CGM despite her wishes that he would.  I told her that my son was exactly the same.
The Diabetes Mine graphic aptly showed both my son’s concerns as well as my own issues with technology.  I thought it was brilliant!
 67% of patients find the technology too expensive. My son and I are in agreement on that count.  He is horrified to think of how much he may have to spend on his diabetes care and threatens to go back on injections if his mother has not convinced the governments to cover his pump costs by the time he needs more help.
The biggest drawback to a CGM is the high cost.  I also agree with this.  My son however is more of the opinion that it is unappealing and uncomfortable (36%) and will further complicate his life (33%) by having him have to carry or wear something else on his body.
I would encourage you to check out this survey in detail. As always the folks at Diabetes Mine have hit on some great points that impact everyone dealing with diabetes. I hope that governments and insurance companies also begin to understand what these 700+ patients have said.  Perhaps then we can see some real change and viable access for everyone regardless of age, wallet size or geography.

The Lost Test Strips

It was recently that time of year again…time to clean out our diabetes supplies.  What once was able to fit in a drawer was now taking up a drawer, a roll-out tote, and underneath of my youngest son’s bed.  This had to stop.  I had no clue that he had supplies hidden in all of these places and was no longer sure as to what supplies we had and what we needed.

We found boxes of Cozmo reservoirs, a few different types of infusion sets, his very first meter, a Polar bear meter holder, way too many lancing devices and enough lancets to keep him going until he is 100.  We also found test strips that were about to expire.  There was no way I was going to waste these strips.  This was $100 and many people can’t even afford to buy them.  The strips would be used at home until such time as they were gone.

My son was fine with that. Like his mother, he loves trying out new meters.  This meter was far from new but since he hadn’t used it in a few years, it was new to him again. The novelty quickly wore off.

“Mom, this meter takes FOREVER to read!”

“How long is forever?”

“15 seconds! Can you believe that? This is crazy!”

I started to laugh! My son was far to used to the immediate gratification found after a five second countdown.  He did not remember the days of his first meter.  Thirty seconds seemed like an eternity and yet I remember back then knowing how lucky we were, the previous generation of meters had taken 60 seconds to show results. 

Despite the “long” wait, he continued to use the old strips.  A few lows and bad sites meant that it did not take more than a few weekends for the 100 test strips to be used up.  I must admit that I had been spoiled too. A few nights of having to wait for those extra 10 seconds did seem like forever.  Nonetheless, it still was not as long as waiting 30 seconds and wondering if your toddler was asleep because he was tired or passed out from a low. 

I love technology!

Diabetes supplies or pay the electricity bill?

Yesterday I went to the pharmacy to order diabetes supplies.  After an initial heart attack when the woman suggested that there was no prescription for one item that I needed for my son, all went well.  When I went back to pick up all of our goodies, the woman at the counter knew our name.  As she tallied up our bill, she hid the screen and said “You don’t want to see this.”  She was right–over $600 spent and that did not include pump supplies. $100 of it was mine but the rest was all to manage diabetes. 

The glucagon kits, that we thankfully have never used (looking for wood to knock on), were over $235 for two.  I am so grateful that they have never been used but was terrified for the families who need it but don’t have the insurance to cover the cost.  We are lucky.  My son’s drugs are covered by his father’s plan.  I pray my son will have a good drug plan on his own one day or I don’t know how he will make it.

$500 for insulin, test strips and glucagon.  There was nothing extravagant in that list.  There were no syringes or pump supplies.  I did not order six months worth of insulin and there are only enough strips there to last 15 days (give or take a few).  That is equal to our grocery bill for a month.  That is rent for a small apartment in some places.  That is the amount of our electricity bill to heat our house during the winter. That is also the amount of money required to keep my son alive for approximately two weeks–scary!

My heart breaks for those who do not have health insurance. Anxiety attacks occur when I think of the fact that my son will have to carefully consider his employment future. He knows what he wants to do with his life but at almost 14, I know that he has not looked to see if that career would give him good benefits.  Benefits are not something that kids should have to worry about. Which is why if I could, I would recommend a European health insurance card type system for everyone here, no child should have to limit their career choices over this. Then again, injecting something into their system on a daily basis to stay alive is not something a child should have to worry about either.

Our province does offer a low income and middle income drug plan.  This will cover some but not all of his supplies if he needed. He would be limited in the number of test strips he could purchase.  He would require special permission to have his insulin covered.  His pump supplies are covered until he turns 25.  This all changes if he decides to live elsewhere in the country.  

I know that there are other countries that have it a lot worse.  We don’t live in those other countries though.  We live in a rich country.  We live in a place with socialized health care.  Despite that fact, people with diabetes and other illnesses, must fight to obtain access to devices and supplies. They cannot chose to have the very best in care unless they also have the very best in insurance plans or bank accounts.  

People say that diabetes does not stop you from doing anything but it does limit your career choices.  We have made some inroads.  There are pilots with Type 1 diabetes and people working as police officers who are living with this disease.  In reality, diabetes has a huge impact on career choices.  If you live with diabetes AND you want tight control, you have to be able to afford it.  The easiest way to do that is to have a great job with even better benefits. 

That needs to change. I am not sure how but it needs to change.  For the time being, we can work on having insulin pumps covered for everyone regardless of age.  The next step will be to have an insurance program that covers everyone regardless of income and despite an existing condition. If you make $100,000 a year then perhaps you can afford a $5000 a year deductible but if you make $25,000 a year then lets be able to offer them $750 a year.  Its something to think about. Its something to work towards… 

Diabetes doesn’t care how big your bank account is

This morning I read a blog post about a woman whose perspective was shifted when she met a homeless young man who was begging for insulin. She commented on how sad it was to live in a society where a person was not begging for money for drugs or alcohol but having to beg for the life saving liquid that he required to flow through his system just to keep him alive.

A few hours after reading this, I received an email from a woman who need help funding an insulin pump.  The coverage that she was sure she had did not icover someone of her age (over 18).  She desperately needs a pump but, like so many, cannot afford to purchase it and the supplies herself. She was curious to know if I was aware of any compassionate programs that could help her out. Unfortunately I don’t.

These two things brought me back to the ugly reality of diabetes–it remains a disease for the rich.  That sounds crazy because we know that diabetes does not care how big your bank account is. It really doesn’t care what type of car you drive, where you work, or how much money your grandmother left you in her will. Diabetes does not care if you are young or old. Diabetes just happens and we somehow learn to live with it.

The sad reality is that some of us can live with it more easily than others. Years ago I wrote about the reality smack I received one Christmas.  I spoke with a friend who had been able to get some test strips to help a family who had a child with diabetes and no insurance coverage.  Two hundred test strips meant the world to this family and would free up $200 for them to buy gifts for their children. I had spent that amount of money on one child without a thought and without having to worry about my son having enough diabetes supplies.

I live in a place that will cover most of my son’s supplies including his insulin pump until he is 25 years old.  That is something that I value because I have no insurance coverage and all of my son’s pump supplies would have to be paid out of pocket if I lived in many other areas of Canada.  The fact that we are lucky to live here also presents another glaring fact, because we are not amongst those who can “afford” diabetes, we are restricted in where we live in order to have the best of care. 

If we lived in Ontario, my son would have all of his diabetes costs covered and I have heard we could even consider putting him on a Continuous Glucose System without having to cover any of the cost.  If we moved to New Brunswick, my son would have no coverage at all and if we moved to British Columbia he would have some coverage.  I have no plans of moving anywhere but am pained that, in Canada, as with the rest of the world, if you have diabetes your ability to receive the best treatment options depend on where you live…or the size of your bank account.

If you can afford the insulin, the test strips, the glucagon kit, the insulin resevoirs, infusion sets, pump, CGMS, and sensors then you can efficiently manage your diabetes to the very best of your ability.  I am not saying that this will guarentee you the best control, but you will have the best tools to help you be the best artificial pancreas you can be.  If you have to pay for your “new” insulin (be it rapid acting or long-lasting) because your province’s formulary only covers things like Regular insulin and NPH then you have to watch your insulin consumption a bit more.  If you have to pay for your own infusion sets then you want to cry each time sweat or rough play causes a site to fall out before at least reaching day three of use.  If you have to pay for your own CGMS then you pray with each sensor that it will last and continue to provide data well after the supposed expiration date.

The items I have listed above are not luxuries.  Its not about having a Hyundai Accent versus a Jaguar.  These items keep our loved ones with diabetes alive, healthy…and ultimately active and productive members of the tax paying community. We have made huge strides in the past ten years regarding improved access to medical supplies and devices. I pray for the sake of my son and so many other people’s children that we make bigger leaps towards seeing no inequity regarding medical coverage in the future.

Why my wallet is red

As the mother of a child with diabetes, I spend WAY too much time at the pharmacy. I do not rely on shipments of supplies once every three months but I am seriously thinking that I have to re-examine the way I do buy supplies. I have been spoiled for a long time. I have been using one pharmacy for ten years. I used to jokingly say that with the amount of money I spend in there in a month, I probably cover the cost of at least one person’s wages.

You may have noticed through different posts, that we have moved over the summer. My amazing relationship with my favorite pharmacy has had to come to an end and I am now in quest of a new and at least civil relationship with a new group.

My first experience with the nearest pharmacy left me crying to my one of my former pharmacists begging for their help to find a better place to go. The new people were not nearly as helpful and their service had been poor. Of course my pharmacist friend came through for me but with moving and summer being insane, I have not yet had a chance to try out her recommendation.

In the meantime, I am still going to the pharmacy just down the road. The biggest shock to my system is the cost. In our old pharmacy, because they knew me and had an understanding with the insurance company that my son’s father used, I walked in, ordered what I wanted, waited five minutes on a busy day, was given our supplies and I walked out of the door without being out of pocket anything. Don’t get me wrong, I knew that in a new city this would not be the case. The insurance company does not have this agreement with all pharmacies. It simply applied to a few in the area where my son’s father worked. That makes sense but also means that now I have to pay all of his supplies out of pocket and then wait for my son’s father to pay me for the supplies. Visa is loving the new system but I am hating it.

It does however give me a new appreciation of things. I physically feel the pain of the uninsured each time I pass that card across the counter and they say “That will be $300.” That is only enough insulin and test strips to last two weeks (I hope). The thought of that doubled was more than what I had been paying for rent on my old house each month! How do people do it? No wonder my wallet is red…its bleeding in the pain of all of the money disappearing from it.  How will my son cope and test as often as he should when he is on his own? He has to get a job with great insurance coverage. Being a child with Type 1 diabetes he has absolutely no choice. That scares me beyond belief. He will have a pump until he is 25 (as long as he stays in this province) but he won’t be able to afford to test. Holy moly!

I have learned that if I am going to survive waiting for the money to come in from my ex-husband to cover the supplies I buy, I have to be much more organized and not stock-pile as much as we once did. Well, unless I stockpile in a monthly purchase! Seriously, I am most likely going to have to send him the receipts on a regular basis (the pharmacy did offer an alternative but I don’t know if he will go for that one or not). To reduce my own debt load while waiting to be paid, it makes more sense for me to learn how many test strips, etc he uses in a month and going in and buying the works at one time. That will be so difficult–being organized and living with diabetes? Can people really do this?

As I have said before, I am easily distracted and in the pharmacy is no different. While waiting for them to bleed my wallet once again I saw it! I have been drooling over the ads and wondering what it would be like to use for months. I have tried to see if I could find a way to get a free one considering how many test strips we use but no way. I saw the price tag and my drool dried up as I thought…that is a box of strips Bud!

What was torturing me so? The new USB Contour. I am a meter junky. I have to try them all. I have yet to find one that I truly love. I have passed the addiction on to my son. If he had been there he would have been begging me to get it. When we spend over $500 on test strips each month, I really can’t justify another $100 for a meter just to see if we like it. My son does love his Contour—the regular one that is. Personally I am not that fussy over it but I do most of my testing at night so my scale is different that his. Oh well, I will keep dreaming and wait until the decide to give them to those of us who use so many strips.

In the meantime, I will just try to black out the pain my wallet keeps feeling each time I walk through those lovely pharmacy doors and pretend that my wallet is only red because I love the color.